Lung cancer screening guidelines

CHICAGO (Ivanhoe Newswire) — Each year lung cancer kills half of those diagnosed and more people than breast, prostate and colon cancers combined. Unlike these other cancers, there’s been no medical agreement on early detection screening for lung cancer.

However, the findings of a national cancer institute trial have resulted in new screening recommendations, and new hope for the seven million American’s who are at high risk for lung cancer.

CT scans have become a yearly ritual for Jody Wilson. After a severe and continuous cough, doctors diagnosed and cured her lung cancer.

“I was absolutely sure if the cancer came back I would know, and I didn't.” Wilson told Ivanhoe.

In 2011, Wilson had no symptoms but doctors found a new cancer in her good lung. Researchers are just now discovering the importance of low-dose radiation chest CT scans in the early detection of lung cancer.

The national cancer institute study shows a 20 percent decrease in mortality compared to x-ray screening.

The new CT scan recommendations address individuals at high risk for lung cancer. For example, those who are 55 to 75 years old, those who smoke or have quit within 15 years and those who smoked at least pack a day for a total of 20 to 30 years.

“If the cancer is found early it can be treated, it can be cured.” Dr. Kapur told Ivanhoe.

Wilson says she understands people’s hesitation but she’s living proof of the benefit of getting tested.

Currently, many insurance companies are not covering the low-dose chest CT scans for lung cancer screening, however some hospitals do offer affordable CT scans for about $200.

LUNG CANCER: Lung cancer is generally defined as an overabundance of abnormal cells in one or both of the lungs. These cells are abnormal because they do not carry out normal cell functions and do not develop into healthy tissue for the lungs. As abnormal cells grow, there is greater risk of the abnormal cells forming a tumor and interfering with the proper function of the lungs. (www.lungcancer.org)

SCREENING: The first diagnosis of lung cancer is determined by the symptoms being shown. Some of these symptoms include coughing up blood, a cough that gradually gets worse and shortness of breath, all of which are associated with lung function. Unlike breast cancer and colon cancer, lung cancer is more difficult to detect. Chest X-rays alone are too unreliable to find tumors in the lungs during the early stages of lung cancer. Screenings with low-dose computed tomography (LDCT) or CT scans are not yet recommended by all medical groups for smokers and former smokers who might be at risk for developing lung cancer. Some high risk factors include being between the ages of 55 to 74 and having smoked for a prolonged period of time in the last 30 years. Doctors suggest an annual screening for high risk individuals. (www.lungcancer.org)

NEW TECHNOLOGY: Recently, it has been determined by radiologists that CT scans are more effective at detecting early stages of lung cancer than chest X-rays. The National Lung Cancer Screening Trial (NLST) showed a reduction in deaths associated with lung cancer after a CT scan screen. The study tested more than 50,000 current and former smokers. The individuals had annual screening tests for three consecutive years and then were monitored for the next five years. The results compared 354 lung cancer deaths from smokers who had a CT scan in relation to 442 lung cancer deaths from smokers who had chest X-rays. These results showed a 20 percent decrease in mortality rate with a CT scan. (www.mayoclinic.org)

Dr. Kapur: Lung cancer is the most common cause of cancer related mortality in the United States and worldwide. In 2010, approximately 200,000 Americans were diagnosed with lung cancer. Of these patients, 160,000 died from their disease. Lung cancer kills more patients than breast cancer, colon cancer, and prostate cancers combined. The reason why lung cancer is so deadly is because patients present it to their doctors at an advanced stage; when the cancer has spread to their body; at which point their options for treatment are very limited. One way to beat lung cancer is to find it when it’s early; when it’s small and before it has spread to the body. In the past, radiologists used chest x-rays to find small nodules in the lungs. But to find small nodules in the lungs, it’s very difficult to do that on chest x-ray. With a CT scan, you can find these lung nodules. The chest CT scan gives us thin slices of the chest which allows us to find small lung cancers and when a small lung cancer is found, we can refer the patient to a chest surgeon who can often times cure the patient of their cancer. The National Lung Cancer Screening Trial has shown us that there is a significant decrease in mortality when a patient is screened with a chest CT scan. Chest CT screening is not meant for everyone. It is meant for patients who are smokers, or former smokers, who are age 55 to 74 years of age and have a greater than 30 year history of smoking. If you think you are at risk for developing lung cancer, you should talk to your doctor about your risk factors. Your doctor can order a chest CT scan for you which should be done every year to look for lung cancer. Unfortunately, at the present time, many insurance companies do not pay for this. However, Weiss Memorial Hospital has significantly discounted the cost of this examination so more people can take advantage of this very effective screening program. I think there is a general fear in the public about being diagnosed with cancer. Often times the word cancer means to them that it’s the end. It’s game over, but that’s not true. If the cancer is found early, it can be treated. It can be cured. So it is my highest recommendation to all smokers who are at risk for developing lung cancers to be screened with this very effective lung screening program.

How does the risk of radiation compare to doing the scan?

Dr. Kapur: The low dose chest CT examination does use radiation; however it is significantly lower than a regular chest CT scan. A regular chest CT examination is not only evaluating the lungs, but it’s also looking at the heart, and other structures in the chest. When we do a low dose chest CT examination, it significantly lowers the dose because we are only looking at the lungs which do not require a very high radiation dose to look at. Even though it is higher than a chest x-ray, it is significantly lower than a regular chest CT scan. The benefits of finding the cancer early far outweigh the negative risk of radiation in a patient who is at risk for developing lung cancer.

Why just smokers? For example, I grew up in Los Angeles where there was a lot of air pollution. Also, what about someone who worked or works in a coal mine abnd has been exposed to other factors?

Dr. Kapur: Right. The present guidelines only address smokers who are at risk for developing lung cancer. There is a significant percentage of patients who are still at risk for developing cancer, however more research needs to be done to identify these patients who are nonsmokers and still develop lung cancer.

Why is it this only group of people? You were talking about false positives.

Dr. Kapur: Right, low dose chest CT screening is limited to patients who are at high risk for developing lung cancer in order to reduce the number of false positives. If we started to screen every patient, there would be way too many false positives. We would find a lung nodule that is not cancer, but it would initiate unnecessary work up. So therefore, lung cancer screening is only limited at the present time to patients who are at an increased risk for developing lung cancer.

Okay, how long have you been using this technology? How long have you been using it for detecting lung cancer? Are you the only hospital that’s doing it and about how many patients have you done it on?

Dr. Kapur: Lung CT screening has actually been around for a long time. People in the past were using chest x-rays to screen patients for lung cancers; however this was not very effective because chest x-rays can miss small lung cancers. Then came the CT scan. We felt that we could diagnose smaller lung cancers with chest CTs much earlier than on a chest x-ray. Other hospitals around the nation have been using low dose chest CT screening for approximately two to three years. At Weiss, our program is at its infancy. We still have to reach out into the community, partner with primary care physicians, and then we hope to see an increase in the number of patients being screened for lung cancer at Weiss Memorial Hospital.

Okay, what’s the procedure like?

Dr. Kapur: The procedure of a CT scan is very simple. The CT scan itself only takes less than 5 minutes to complete. It does not require any IV contrast or dye, so the patient does not even require an IV. Your doctor will send us an order and you come in at your appointment time. We take you into the CT scanner. The CT scan itself takes maybe 2 minutes to complete, and that’s it. You have your results right there and then.

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